Treatment of lentigo maligna with total circumferential margin control using vertical and horizontal permanent sections: A retrospective study

Abstract

This retrospective study assesses the long-term cure rate for the treatment of lentigo maligna using total circumferential margin control with vertical and horizontal permanent sections using life-table analysis. A cohort of 31 patients in Sydney with lentigo maligna treated with total circumferential margin control with vertical and horizontal permanent sections over a 6-year period were followed up. Follow up to determine recurrence was obtained by direct examination, by contact with the referring dermatologist, general practitioner, or by telephone interview with the patient's relative if the patient was deceased. Following our total circumferential margin control technique, of the 16 primary tumours, only one recurred (a cure rate of 94%). Of the 15 recurrent tumours, two had recurred. The mean follow-up time in this study was 42 months (range 12-89 months). Kaplan-Meier analysis estimated that at 5 years, 87% of patients would be free from disease (95% confidence interval 70-100%). Seventy-five per cent of the population can be expected to be disease-free for 6 years (lower 95% confidence limit 4 years). We describe the use of total circumferential margin control with vertical and horizontal permanent sections for the treatment of lentigo maligna that we believe is simple, effective and reproducible.

Guidelines of care for the management of primary cutaneous melanoma

“…Specific techniques include the ''square'' procedure (and associated variations), ''spaghetti technique'' (and variations), ''slow Mohs,'' staged excision with radial vertical sections, and mapped serial excision techniques. 87,126,[133][134][135][136][137][138][139][140][141][142] No study directly comparing these staged excision techniques has been conducted. Like MMS, all staged excision techniques involve removal of the majority of the clinically apparent lesion for histologic microstaging.…”

A Randomized Trial of the Off-label Use of Imiquimod, 5%, Cream With vs Without Tazarotene, 0.1%, Gel for the Treatment of Lentigo Maligna, Followed by Conservative Staged Excisions

“…Previously published recurrence rates hover around 6% for staged excisions alone. 4,[20][21][22] We would argue that the morbidity of standard staged excisions can be greatly reduced if the patient is pretreated with topical imiquimod before a staged excision, without undue added risk to the patient.…”

Surgical Treatments for Lentigo Maligna: A Review

“…A variation of MMS that Lee and Ryman have explored is total circumferential margin control (TCMC) 56 (Table 2). Briefly, the lesion is delineated using a Wood's lamp along with 5‐mm margins.…”